WORKING DOCUMENT Version 5 DRAFT LOCAL ENHANCED SERVICE SPECIFICATION Palliative Care

Transcription

1 Appendix F WORKING DOCUMENT Version 5 DRAFT LOCAL ENHANCED SERVICE SPECIFICATION Palliative Care Introduction 1. The LES has been introduced to embed good clinical practice and effective performance management in End of Life Care (EOLC) based on supporting evidence and recommendations from NICE standards and guidance for EOLC and Cancer, the Palliative Care Funding Review and national and local End of Life Care strategies. 2. It is the CCG s expectation that all Practices will sign up to and deliver the Palliative Care LES. 3. The LES is based on the Gold Standards Framework for Palliative Care (GSF) and has been adapted for local use. Information on the Primary Care GSF is accessible on the website address: 4. The Palliative Care LES does not seek to replace specialist palliative care, oncology or other secondary services but rather to improve assessment, communication and planning in primary care so that these services are accessed appropriately. Aim 5. The aim of the Palliative Care LES is to focus on quality of life and support patients to die in their preferred place of care and reduce where appropriate unscheduled admission to hospital Evidence 6. There is a growing body of evidence that hospital is neither the preferred nor the optimal environment for end of life care. Healthcare for London s End of Life Care: Good Practice Guide points to many deaths occurring in hospitals (66% in London compared to a national average of 58%) but, when people were asked about their preferred place of death, between 56% - 74% of people cited their own home. 7. The Gold Standards Framework has been cited as a best practice model for improving standards of care for patients and their carers with cancer, AND nonmalignant conditions such as severe heart failure or COPD. Entry Criteria 8. Practices produce a register of palliative care patients and has signed up to the Gold Standard Frame work 9. The Practice must have named clinical and administrative coordinator for the LES 10. Practices are reminded that the Palliative Care Register should reflect patients who are suffering from life illness (cancer or non-cancer) where death is anticipated within next 12 months Page 1 of 10

2 11. Practices sign up to the End of Life Care Patients Charter the relevant name and contacts will be added to the charter Practices will be expected to discuss the Charter as a primary health care team, through multidisciplinary meetings with representation from the community and palliative care nurses you work with. Evidence that meetings have facilitated reflective practice. 13. Seek views from your patient group, feedback must be sought from patients and/or carers who have experience of using the EOLC pathway. 14. Details of the patients charter must be made available within the practice. Details should include clinical GP lead and administrative lead for the practice. 15. Display the Charter in your waiting room and include it in your practice information pack. 16. Use the Charter as a standard against which to review your care. Such review/ audit could be included as one of the aspects of your own appraisal and revalidation of practice accreditation. 17. If you feel you need help in implementing certain aspects of the Charter or require further training and support, discuss them with your local EOLC team/ facilitators, or visit the RCGP website at or the GSF website at Eligibility Criteria 18. All patients registered with your practice who are identified as being in their last 6-12 months of life will receive this service, all clinical diagnosis meeting the requirements for EOLC. Exclusion Criteria 19. Patients not registered with your practice, patients who move temporarily out of the borough, patients under the age of 18 due to clinical governance Essential Services and Support 20. CCG clinical lead for Palliative Care, Dr Camilla Chambers 21. St Christopher s GSF facilitator, Jo Hockley 22. CHS Palliative Care Team 23. Marie Curie Night sitting service to support carers Interdependencies 26. Community and Acute Palliative Care Teams 27. Voluntary sector providers 28. Independent sector providers 29. Social care 30. Community pharmacists Payment 31. Standards 1-6 are mandatory requirements for practices to qualify as a provider of this service. Page 2 of 10

3 32. Standards 7 and 8 although not mandatory will generate an additional payment for practices. Standards Practices will receive an annual payment of 1800 subject to meeting the requirements to support the maintenance of the palliative care register and on-going review of patients needs. Standard Practices meeting requirements to support the development of proactive care of patients with the learning of Co-ordinate my care, Advanced Care Planning and/or Communication skills training. Standard In respect of standard 7 payments will be processed on a quarterly basis upon receipt of the After Death Analysis spreadsheet, a total of 15 will be paid per ADA subject to fulfilment of criteria Standard A single payment is payable at the end of the year when the audit and meeting notes are received. Practice will be paid a further 400 where standard 8 is met. Standard Description Method of monitoring Palliative Care 1 Palliative Care 2 The practice requires up to date registration on the GSF website, new practices will need to register to qualify for payment. The practice has a named clinical and admin coordinator for palliative care Information to be submitted on return attached. Information to be submitted on Audit and Monitoring Form. Payment 1800 per practice 100% compliance Page 3 of 10

4 Palliative Care 3 Palliative Care 4 Palliative Care 5 An advanced care plan is compiled for each patient on the EOL register, this ACP must include the following: - Patient s concerns Anticipated needs Preferred place of care DNACPR Anticipatory medicines OOH details if differ from normal Use of palliative care communication: use of electronic methods and/or a Palliative Care Whiteboard (or equivalent) Monthly minuted meetings to review those currently on the palliative care register and those that have passed away. Evidence that Practices have gained informed consent from patients to include their records on CMC and placed patients on CMC, if the patient decides not to consent to be included on CMC this data will be acknowledged on the ACP and on ADA forms Palliative care communication: use of electronic methods and/or a Palliative Care Whiteboard or equivalent Anonymised ADA forms to be completed. Evidence of an MDT approach to discussions (lack of attendance from MDT at times. 4 Copies of anonymised minutes or other evidence of meetings, actions taken and specific outcomes for patients Evidence shown in ACP and on ADA forms. Will be discussed in minuted monthly meetings Page 4 of 10

5 Palliative Care 6 Completion of the following courses: Co-ordinate my care (for both clinical GP lead and practice manager/administr ative lead) Advanced Care Planning Communication Skills GP lead will choose between ACP or CS course this will then need to be co-ordinated in house to ensure full GP coverage within the practice. Evidence will be through certificates stating completion of training No payment Discretionary - However practices will benefit from the advanced learning offered with these courses Palliative Care 7 Completion of after death analysis spreadsheets, Advanced care plans and inclusion on the palliative care register (where applicable) for each patient registered with the practice those that have been sent into hospital to die rather than being cared for in preferred place of death.is mandatory to receive payment. Quarterly return of after death analysis spreadsheet which is included in the individual payment workbooks. 15 per completed ADA 100% compliance The after death analysis spreadsheet will also need to be completed for those patients not on the register that have died in hospital of Long Term Condition or Co-morbidities (learning will be needed to understand why these patients have not fallen within the EOLC radar) Page 5 of 10

6 Palliative Care 8 Significant Event Analysis Meetings to identify palliative care caseload and demonstrate that a minimum of 60% of patients die within their preferred place of care. Determinance as to why patients do not die within their preferred place of care should be analysed and reported at this meeting. Show minutes as evidence of where changes can be made to produce favourable outcomes 400 per practice per year if appropriate reflective practice is demonstrat ed in minutes of meetings. Discretionary These are to be carried out on a bi-annual basis. General Information This specification outlines work to be undertaken in addition to all other primary care responsibilities. Achievement of the other primary care performance and quality indicators are not sufficient to meet the requirements of this enhanced service. Practices must use READCODES in data capture as the CCG will be undertaking independent audit of LES activity Croydon CCG will work with Out of Hours providers to agree what information will be required Review and Future developments Croydon CCG will evaluate the service at the end of the LES contract period and the data will be used to inform decisions about future service provision. This service specification will be reviewed on an annual basis within the contract period. Croydon CCG reserves the right to withdraw or amend this service and will give a minimum of 3 months notice of any service changes. Data Capture To aid uniformity in the collection and analysis of data for this LES it is recommended that the following method of data capture is followed: 1. Keeping a palliative care register as required for QOF (using code ZV57C) and then using a new code for the GSF LES (8CM1) 2. Using a GSF LES template with the following codes for the various elements of the LES PPC 8CN1 - further broken down into Home -94Z Hospice - 94Z2 Hospital - 94Z4 Nursing Home-94Z5 Page 6 of 10

7 Community hospital 94Z3 Place of death 949 (and branches). DNARCPR Resuscitation discussed with patient - 67P0 (zero) Resuscitation discussed with carer 67P1 For resuscitation 1R0 Not for resuscitation - 1R1 Patient awareness of diagnosis 1H0../1H1.. (zero Advance Care Planning Has an Advance Care Plan - 8CME OOHS handover - 9e2 PCRT - 8CM3 Anticipatory prescribing information/jicb - 8BMM DS1500-9EB5 DS1500 discussed 9EB5/67430 Carer details Putting the PCRT on the clinical system as a template and filling this in at each review meeting. 4. Printing and faxing the completed PCRT to the OOHS or completing the OOHS form in the Palliative Care Folder after each meeting, with a monthly list of patients on the Palliative Care Register. 5. Auditing by searching on the palliative care register (ZV57C) the filed PCRTs (8CM3) the PPC (8CN1) the DNACPR (1R0 and 1R1) the OOHS (9e2) the JIC Box (8BMM) the DS1500 (9EB5/67430) the carer s details (9180) Page 7 of 10

8 Practice Sign-up Sheet Return signed copy to Croydon Clinical Commissioning Group Signature of Parties Level of Local Enhanced Service: please mark the appropriate Standards 1-5 Standard 6 Standard 7 Standard 8 Yes/No Yes/No Yes/No Yes/No The signatures below constitute an agreement between the GP Practice and Croydon Clinical Commissioning Group for the Palliative Care LES This service is commissioned until 31 March By signing this agreement the GP practice is agreeing to the CCG Commissioners extracting data on a regular basis via EMIS Web for this LES for audit and payment purposes. Lead GP Name (Print): Signature: Date: Croydon CCG (Print): Signature: Date: Please note that the LES will only be valid when the practice has received by return a signed copy by Croydon CCG Please return to: Amanda White. amanda.white@croydonpct.nhs.uk Page 8 of 10

9 Return Form Information to evidence achievement of LES Palliative Care 2013/14 Complete on 31 st March 2014 please return by 30th April 2014 Practice/Senior Partner: Start date: From: Name of person completing this form: Please complete the right hand column: Palliative care 1: Number of patients on your practice palliative care register at end of each quarter and number of patients with diagnosis other than cancer. Total number on palliative care register June Sept Dec Mar Number on palliative care register not cancer June Sept Dec Mar Palliative care 2: The practice has a named clinical and admin coordinator for palliative care Palliative care 3: Number of patients on your practice palliative care register with an Advanced Care Plan at end of each quarter. Clinical NAME: Admin NAME: Total number on palliative care register with Advanced Care Plan (completed ADA s must demonstrate the use of advanced care planning) June Sept Dec Mar Palliative care 4: Monthly minuted meetings to review those currently on the palliative care register and those that have passed away. Practices must provide 4 copies of MDT meetings for the year, we will also need evidence of an MDT approach ( s advising the relevant teams of the meeting dates etc) Page 9 of 10

10 Palliative care 5: Number of patients that have given consent to be placed on the CMC register and those that have declined to be added. Total number on CMC register June Sept Dec Mar Number declined to be added onto CMC register June Sept Dec Mar Palliative care 6: Completion of Co Ordinate my Care training by GPs and practice managers, and participation in either the advanced care planning or communications skills course for GPs Palliative care 7: Completion of after death analysis spreadsheets, Advanced care plans and inclusion on the palliative care register (where applicable). The after death analysis spreadsheet will also need to be completed for those patients not on the register that have died in hospital of Long Term Conditions or Co-morbidities (learning will be needed to understand why these patients have not been managed in line with EOLC pathway) Copy of certificate of attendance needs to be submitted Copies of ADAs should be entered onto the relevant page on the individual practice LES workbooks and be submitted on a quarterly basis to Amanda.white@croydonpct.nhs.uk Palliative care 8: Significant Event Analysis Meetings to determine appropriate cohort on Palliative Care, to determine that a minimum of 60% of patients are dying in their preferred place of care. Copies of both minuted meetings are required to fulfil standard 8. These are to be carried out on a bi-annual basis. Return to Amanda White amanda.white@croydonpct.nhs.uk Page 10 of 10